{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HARMONY MCKEEVER","gend":1,"add":"3   JADE COURT","city":"PALMYRA","state":"VA","zip":22963,"dob":"1978-04-24","age":"","mstatus":"","insh":4076878,"cliId":"","pno":4343054009,"cno":"","email":"","ename":"","eno":"","pphy":"KOHLI, PRIYA","ppno":4343054009,"pcpadd":"115 AMBRIAR PLZ,","pcpcity":"AMHERST","pcpstate":"VA","pcpzip":24521,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/CHARLOTTESVILLE","aligned":"","ano":"","add2":"3   JADE COURT","add3":"","madd1":"3 JADE COURT","madd2":"","madd3":"","mcity":"PALMYRA","mstate":"VA","mzip":"22963-2033","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","R07.89","S29.012A","K59.09","K59.00","F41.9","E10.9","E10.8","Z79.4","I10","J06.9","B97.89","M54.5","E10.65","R80.9","E86.0","R07.9","R11.10","R40.4","R53.1","R50.9","R79.89","R06.02","M54.6","M79.604","E10.22","I12.9","F17.210","N18.3","E10.40","J44.9","R06.9","R11.2","E10.319","R68.89","N91.2","E10.21","E10.69","R03.0","R00.2","Z11.59","R19.7","Z72.0","F19.21","Z96.41","I25.10","Z00.00","R10.30","Z13.31","Z23","R63.4","N64.3","Z01.419","R10.2","Z11.51","Z12.4","Z12.31","R35.0","R10.32","E10.59","Z91.89","K31.84","J40","K59.03","K31.7","K31.89","R10.11","E11.9","Z20.822","R53.81","M79.10","Z98.890","T50.Z95A","E11.65","T80.69XA","H61.21","R60.0","E87.1","K21.9","R05","R14.0","M79.89","R53.83","T50.905A","R91.8","R19.5","K86.89","M79.672","M79.675","M12.572","M19.072","I25.118","M25.532","M79.645","R22.32","F17.200","R41.3","E11.22","N18.9","E11.43","M54.9","G89.29","F11.11","Z88.0","Z88.1","Z88.8","R11.0","Z80.3","R05.9","J01.00","R10.10","E13.65","R00.0","R68.83","E10.43","K63.89","R10.84","M25.511","S29.9XXA","S43.101A","X58.XXXA","S43.51XA","M65.30","M66.342","M65.332","E10.42","R42","R51","J02.9","J01.90","H92.02","E78.2","M79.605","E55.9","J98.11","M79.662","R06.09"],"date":["2022-04-01","2020-01-23","2020-01-23","2021-06-01","2020-01-23","2021-10-05","2022-03-01","2021-11-22","2021-11-22","2022-03-21","2020-03-03","2020-03-03","2020-04-30","2021-11-22","2020-04-30","2021-10-10","2022-03-19","2022-03-19","2020-04-30","2021-10-10","2020-05-01","2020-04-30","2020-07-11","2021-06-01","2020-04-30","2022-03-03","2020-07-28","2020-04-30","2020-07-28","2020-05-01","2020-04-30","2020-05-01","2021-11-22","2020-05-01","2020-07-12","2020-09-29","2022-03-03","2020-10-01","2020-07-11","2020-07-11","2020-07-11","2022-03-19","2020-07-15","2020-07-15","2020-07-15","2020-07-28","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-30","2020-09-29","2020-10-02","2020-09-29","2020-09-29","2021-10-29","2020-09-29","2020-10-02","2022-03-21","2021-08-11","2021-11-22","2021-11-18","2021-01-12","2021-02-15","2021-02-15","2021-04-11","2021-04-11","2021-04-11","2021-11-22","2021-05-04","2021-04-11","2021-04-11","2021-04-11","2021-06-03","2021-05-04","2021-07-01","2021-06-01","2021-08-11","2021-06-01","2021-06-01","2021-07-08","2021-06-03","2021-06-03","2021-06-04","2021-06-04","2021-06-04","2021-07-07","2021-07-07","2021-07-08","2021-07-08","2021-08-12","2021-10-08","2021-10-08","2021-09-10","2022-03-19","2021-09-27","2022-03-19","2021-11-22","2021-10-10","2021-11-22","2021-10-10","2021-10-10","2022-03-19","2022-03-19","2022-03-19","2021-10-10","2021-10-29","2021-11-18","2021-11-18","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-23","2021-11-23","2022-03-19","2022-03-19","2022-03-19","2022-03-19","2022-03-21","2019-01-08","2019-01-08","2019-01-08","2019-08-15","2019-02-14","2019-02-14","2019-03-01","2019-04-02","2019-03-01","2019-07-02","2019-08-15","2019-08-15","2019-08-15","2019-08-15","2019-08-20"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","10370010250","BUPROPN","10370010250 BUPROPN ","30","Select","Select",""],["","70377002911","ATORVASTATIN","70377002911 ATORVASTATIN ","90","Select","Select",""],["","00093220305","METOCLOPRAM","TAB 10MG","120","Select","Select",""],["","16729018317","HYDROCHLOROT","16729018317 HYDROCHLOROT ","30","Select","Select",""],["","43598051090","ESOMEPRA","43598051090 ESOMEPRA ","90","Select","Select",""],["","76385011350","CARVEDILOL","76385011350 CARVEDILOL ","180","Select","Select",""],["","62175011937","ISOSORB","62175011937 ISOSORB ","90","Select","Select",""],["","68180072103","AMLODIPINE","68180072103 AMLODIPINE ","90","Select","Select",""],["","65862052890","VENLAFAXINE","65862052890 VENLAFAXINE ","43","Select","Select",""],["","52817033200","CYCLOBENZAPR","52817033200 CYCLOBENZAPR ","30","Select","Select",""],["","68180096301","ALBUTEROL","68180096301 ALBUTEROL ","8.5","Select","Select",""],["","60258017101","MAG","TAB 400MG","90","Select","Select",""],["","68001041103","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","00904645780","DOK","00904645780 DOK ","60","Select","Select",""],["","00088222033","LANTUS","00088222033 LANTUS ","10","Select","Select",""],["","55111039905","LANSOPRAZOLE","55111039905 LANSOPRAZOLE ","90","Select","Select",""],["","64764017130","DEXILANT","64764017130 DEXILANT ","60","Select","Select",""],["","68001016100","PROMETHAZINE","68001016100 PROMETHAZINE ","20","Select","Select",""],["","00573245028","NEXIUM","CAP 20MG","56","Select","Select",""],["","00169750111","NOVOLOG","00169750111 NOVOLOG ","30","Select","Select",""],["","00904699880","DOCUSATE","00904699880 DOCUSATE ","60","Select","Select",""],["","51224012230","AZITHROMYCIN","51224012230 AZITHROMYCIN ","60","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","14.00","Select","Select",""],["","00193731150","CONTOUR","00193731150 CONTOUR ","150","Select","Select",""],["","42858010301","OXYCOD\/APAP","TAB 7.5-325","20.00","Select","Select",""],["","59746017310","PREDNISONE","59746017310 PREDNISONE ","15","Select","Select",""],["","69315011610","FUROSEMIDE","69315011610 FUROSEMIDE ","60","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","7","Select","Select",""],["","68001024617","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","50428026496","CVS","TAB 8.6MG","30","Select","Select",""],["","60505082901","FLUTICASONE","60505082901 FLUTICASONE ","16","Select","Select",""],["","68462063801","NITROGLYCERN","68462063801 NITROGLYCERN ","100","Select","Select",""],["","45802086803","POLYETH","45802086803 POLYETH ","510","Select","Select",""],["","00172392770","DIAZEPAM","TAB 10MG","20","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30.00","Select","Select",""],["","11523726803","MIRALAX","POW 3350 NF","30.00","Select","Select",""],["","00591352530","LIDOCAINE","00591352530 LIDOCAINE ","30","Select","Select",""],["","00548585000","GLUCAGON","00548585000 GLUCAGON ","2","Select","Select",""],["","51672400101","NORTRIPTYLIN","CAP 10MG","90","Select","Select",""],["","53885013610","ONETOUCH","MIS LANCETS","100","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10.2","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","90","Select","Select",""],["","00168020230","CLINDAMYCIN","GEL 0.01","30","Select","Select",""],["","00574110416","BROM\/PSE\/DM","SYP ","115","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"comment":[["","",""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}